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WELCOME BACK

Health Insurance Plans: Coverage Through Your Job

Stanford Health Care is in-network with most major commercial health plans that employers offer their employees.

Some employers choose to offer “narrow” networks that have limited options in their network. You should always check with your employer’s benefit department or your health plan to determine if there are any unique or narrow networks within your coverage.

Stanford Health Care is contracted and in-network with the following employer-sponsored group plans.

Aetna

If you have an HMO plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician must refer you and your medical group or health plan must authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If you have a PPO/EPO/POS plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

If you have an HMO plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician must refer you and your medical group or health plan must authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If you have a PPO/EPO/POS plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

If you have an HMO plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician must refer you and your medical group or health plan must authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If you have a PPO/EPO/POS plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

Stanford Health Care and its physicians are in-network with out of state Blue Cross/Blue Shield plans, as long as the plan uses the nationwide network of providers. This is known as the Blue Card network. Most employer sponsored group plans will include this network, especially if they have employees located in multiple states. Please contact your health plan or your employer to inquire about access to this network.

If you have an HMO plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician must refer you and your medical group or health plan must authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If you have a PPO/EPO/POS plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

If you have an HMO plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician must refer you and your medical group or health plan must authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If you have a PPO/EPO/POS plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

If you have an HMO plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician must refer you and your medical group or health plan must authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If you have a PPO/EPO/POS plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

This is a health plan offered by Stanford University to Stanford University students. It is an EPO plan, and Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

If you have an HMO plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

In order to be seen at Stanford Health Care, your primary care physician must refer you and your medical group or health plan must authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If you have a PPO/EPO/POS/OAP plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

If you have an HMO plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician must refer you and your medical group or health plan must authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If you have a PPO/EPO/POS plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

If you have an HMO plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician must refer you and your medical group or health plan must authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If you have a PPO/EPO/POS plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

If you have an HMO plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician must refer you and your medical group or health plan must authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If you have a PPO/EPO/POS plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

If you have an HMO plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician must refer you and your medical group or health plan must authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If you have a PPO/EPO/POS plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

Kaiser HMO members must obtain a referral from their Kaiser primary care or specialist physician and an authorization from their health plan for any services to be covered and considered in-network here at Stanford Health Care. You would not be able to select a Stanford Health Care physician as your primary care physician.

Stanford Health Care and its physicians are in-network providers with Sutter Select. Sutter Select’s provider network is comprised of Sutter Health hospitals and physicians, and they extend their network by contracting with non-Sutter providers as needed. However, Sutter expects that services will be provided by its own Sutter provider network and will only grant authorizations as an exception.

If you have the PPO plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician. Prior authorization is encouraged so patients receive Tier 1 benefit levels. If authorization is not granted by Sutter Select, the services may be considered out of network, or at a lower tier benefit level.

If you have the EPO or EPO Plus plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician. Prior authorization is required for all services in order for the services to be covered. Sutter Select will only authorize the services if there aren’t any Sutter Health providers available in their own network that can provide the service.

If you have an HMO plan: Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician would need to refer you and your medical group or health plan would need to authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If you have a PPO/EPO/POS plan: Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician must refer you and your medical group or health plan must authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

If your health plan is not included on the list of in-network plans, that means that Stanford Health Care most likely does not have a contract with your plan. You can email the Managed Care Department for confirmation.